Company :Highmark Inc.Job Description : 

JOB SUMMARY

This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizes data/analytics in conjunction with professional clinical judgement to identify the right clinical/lifestyle intervention for each member.  The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources.  The incumbent conducts outreach to members enrolled in disease management including but is not limited to, developing a personalized care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals. The incumbent engages with the member panel telephonically, digitally, or virtually to achieve improved health outcomes. The incumbent monitors, improves and maintains quality outcomes (clinical, financial and functional) for the specified panel of members.

ESSENTIAL RESPONSIBILITIES

Maintain knowledge of evidence based interventions and industry standards to deliver high quality lifestyle coaching in the areas of tobacco cessation, weight management, sleep hygiene, stress management, nutrition, physical activity and maternal health.Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support.For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources (internal and external), and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment of progress towards goals. .Demonstrate clinical outcomes and cost savings based on wellness interventions and provide support to all members across all age bands, geographic regions, and products.Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements,  professional scope and accreditation standards.Participates in workgroups focused on continually improving the efficiency, effectiveness, and member-centric focus of the wellness coaching services, including but not limited to the development and implementation of new programs and pilots.Other duties as assigned or requested.

EDUCATION

Required

Master's Degree in Nutrition, Health Education, Health Promotion, Exercise Science, Public Health, Social Work/Psychology, Health or Clinical related field

Substitutions

None

Preferred

None

EXPERIENCE

Required

3 years as a Registered Dietician OR Exercise Physiologist OR Wellness/Lifestyle Coach in an environment that focuses on a wellness model or program delivery (i.e. health plan/insurance, disease or condition management or inpatient/outpatient acute care)

Preferred

None

LICENSES or CERTIFICATIONS

Required

None

Preferred

Certified Tobacco Cessation specialistRegistered DieticianCertified Diabetes Educator (CDE)Exercise Physiology certificationCertified Lactation CounselorNational Diabetes Prevention Program Lifestyle CoachCertified Health and Wellness Coach (CHWC)

SKILLS

Familiarity with Highmark’s preventative health services programs & servicesEffective presentation skillsStrong relationship builderSkilled in basic computer skills and software applications including Microsoft TEAMS.Comprehensive knowledge and understanding of current health education practicesKnowledge of Prochaska’s Transtheoretical Stage of Change modelExperience working in a team environment that supports the management of health services and/or wellness programExcellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organizationAbility to work in a high performing team environment that requires flexibilityDemonstrated ability to handle multiple priorities in a fast paced environmentExcellent organizational, time management and project management skillsSelf-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy

Language (Other than English):

None

Travel Requirement:

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

Yes

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Occasionally

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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